Provider Demographics
NPI:1194320598
Name:CAMINO-BENECH COMPANY, LLC
Entity type:Organization
Organization Name:CAMINO-BENECH COMPANY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YAMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BENECH-JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:281-909-0102
Mailing Address - Street 1:8622 S BRAESWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77031-1301
Mailing Address - Country:US
Mailing Address - Phone:281-909-0102
Mailing Address - Fax:281-909-0105
Practice Address - Street 1:8622 S BRAESWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77031-1301
Practice Address - Country:US
Practice Address - Phone:281-909-0102
Practice Address - Fax:281-909-0105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-02
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX408249701Medicaid